Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twelve patients with progressive systemic sclerosis (four with CREST [calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia] variant) underwent systematic evaluation to assess the esophagogastric effects of metoclopramide hydrochloride in this patient population. Esophageal manometry, esophageal radionuclide scintigraphy, solid-phase gastric emptying, and 24-hour esophageal pH monitoring were performed in all patients with and without metoclopramide. Metoclopramide improved lower esophageal sphincter pressure and reduced the gastric emptying delay and gastroesophageal reflux in most patients but had a less consistent effect improving esophageal transit or esophageal body pressures. Metoclopramide should be strongly considered in the pharmacologic approach to the gastroesophageal reflux-related complications of this disease.
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PMID:Metoclopramide response in patients with progressive systemic sclerosis. Effect on esophageal and gastric motility abnormalities. 363 68

Foregut drug receptors permit inotropic manipulation of the dysmotility pattern associated with gastroesophageal reflux (GER). Two prokinetic agents, ie, Metoclopramide and Cisapride were assessed in 18 infants with severe GER (mean age 6.5 months) by means of 18-hour continuous intraesophageal pH monitoring. Six parameters were recorded, and the results compared before and during pharmacologic stimulation. Both agents improved the parameters measured, but Cisapride was found to be more effective in enhancing lower esophageal sphincter competence and esophageal motor function. Long-term assessment of both agents in the management of GER in infants is indicated.
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PMID:Esophageal pH assessment of gastroesophageal reflux in 18 patients and the effect of two prokinetic agents: cisapride and metoclopramide. 368 25

Gastric emptying has been reported to be delayed in a significant percentage of patients with gastroesophageal reflux. The rationale for the use of metoclopramide and bethanechol in gastroesophageal reflux has been based on their ability to stimulate lower esophageal sphincter pressure and enhance acid clearance mechanisms. In this study, we investigated the comparative efficacies of metoclopramide and bethanchol in improving the rate of gastric emptying in gastroesophageal reflux patients in whom delayed emptying was present. Gastric emptying studies used an isotope-labeled mixed solid-liquid meal. Thirteen reflux patients with delayed gastric emptying received metoclopramide, 10 mg intramuscularly, and subcutaneous bethanechol, 0.07 mg/kg, in a randomized single-blind fashion. Eleven additional reflux patients with delayed gastric emptying received oral metoclopramide, 10 mg, in an open-labeled fashion. After parenteral metoclopramide, gastric emptying was significantly (p less than 0.05) faster compared with both the initial basal day and the bethanechol treatment day. Compared with the normal gastric emptying rate established in 26 control subjects, metoclopramide accelerated gastric emptying into the normal range. Bethanechol did not increase gastric emptying. Metoclopramide orally also significantly improved gastric emptying. Our study indicates that metoclopramide, both parenterally and orally, increased the rate of gastric emptying in those reflux esophagitis patients in whom it was delayed, while bethanechol did not improve the degree of gastric retention in the same patients. Our results extend the rationale for the therapeutic efficacy of metoclopramide in gastroesophageal reflux disease.
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PMID:Effects of metoclopramide and bethanechol on delayed gastric emptying present in gastroesophageal reflux patients. 613 52

Ten patients with gastroesophageal reflux disease participated in a randomized, double-blind, crossover study in which they received a single 20-mg oral dose of metoclopramide or a placebo 15 minutes before a provocative test meal. All patients had previously been challenged with the test meal and had exhibited symptoms of heartburn and regurgitation. Metoclopramide reduced the severity of heartburn from the onset, its effect reaching statistical significance within two hours and persisting for at least five hours. Eighty percent of the patients who received metoclopramide, compared with only 30% of placebo-treated patients, were completely free of heartburn at the end of the trial. A significant reduction in regurgitation during the 1 1/2 to four hours after the test meal was also noted with metoclopramide. No adverse effects occurred. The ability of metoclopramide to prevent the symptoms of heartburn and regurgitation induced by a provocative meal in patients with gastroesophageal reflux was clearly demonstrated.
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PMID:Prevention of meal-induced heartburn and regurgitation with metoclopramide in patients with gastroesophageal reflux. 676 Sep 68

Decreased lower esophageal sphincter pressure, transient relaxations of the lower esophageal sphincter, and acute increases in intra-abdominal pressure are among the most common pathogenic factors in gastroesophageal reflux. This study examines the effect of metoclopramide on these factors in patients with gastroesophageal reflux disease. Six patients with clinical and endoscopic evidence of esophagitis underwent esophageal manometry and intraesophageal pH monitoring over a 5-h period (1 h basal, and 4 h postprandially). The study was done on three different days: on day 1, after placebo, on day 2, after 10 mg po metoclopramide (order randomized), and on day 3, after metoclopramide 10 mg po quid for 7 days. Metoclopramide given for 1 wk significantly increased the basal lower esophageal sphincter pressure as compared to placebo and a single dose (p < 0.05). It also significantly decreased reflux episodes during the 3rd and 4th hour postprandially when given both as a single dose or after 1 wk of treatment. There was no significant difference in the other parameters measured. Repeated metoclopramide doses decrease reflux episodes in patients with reflux esophagitis by increasing basal lower esophageal sphincter pressure and possibly by accelerating gastric emptying.
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PMID:Effect of single and repeated doses of metoclopramide on the mechanisms of gastroesophageal reflux. 821 4

Delayed gastric emptying of formula is observed in many infants with gastroesophageal reflux but the mechanisms responsible for this observation are not defined. Postprandial gastric motility was quantified using a perfused catheter placed into the distal stomach of five infants with gastroesophageal reflux and delayed gastric emptying of 99mTc-sulfur colloid-labeled formula. Five infants with reflux who exhibited normal emptying of formula served as the controls. Gastric motility indices were calculated for 60 min following a meal. Half the patients in each group were given metoclopramide following a 30-min recording period. In both groups, postprandial gastric motility was similar and characterized by minimal gastric contractions. Metoclopramide resulted in increased amplitude and duration of antral contractions, but no significant differences were noted between groups. The findings suggest that minimal delays in gastric emptying in infants with gastroesophageal reflux are not associated with significant alterations of postprandial gastric motility.
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PMID:Postprandial gastric motility in infants with gastroesophageal reflux and delayed gastric emptying. 825 98

Prokinetic agents are currently being investigated as potential therapies for motility disorders of the lower gastrointestinal tract. Cholinergic agonists such as bethanechol are known to improve postoperative ileus but are limited because of side effects. Dopamine antagonists such as domperidone appear to have maximal prokinetic effect in the proximal gastrointestinal tract and are effective for such conditions as gastroparesis and gastroesophageal reflux, but they appear to have little physiologic effect in the colon or in colonic motility disorders. Naloxone, an opioid antagonist, appears to hold promise in patients with irritable bowel syndrome, small intestinal pseudo-obstruction, and constipation. Erythromycin exerts its prokinetic effect by acting as a motilin agonist; it has been used in the treatment of diabetic gastroparesis and appears to improve symptoms of colonic pseudo-obstruction and postoperative ileus. Metoclopramide, a combined cholinergic agonist and dopamine antagonist, is currently used exclusively for proximal motility dysfunction. Cisapride appears to hold the most promise for patients with colonic motility disorders. In patients with postoperative ileus, cisapride is associated with an increased return of bowel function compared with placebo. In patients with chronic constipation, cisapride increases stool frequency and decreases laxative abuse in both adults and children. Hopefully, as an understanding of gastrointestinal motility increases, effective prokinetic agents will be developed that will improve symptoms of patients with large bowel motility disorders and may also help to predict those patients who benefit from surgical management for constipation.
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PMID:Prokinetic agents for lower gastrointestinal motility disorders. 813 79

In a prospective study, 180 infants, mean age 2-6 months, hospitalized for apparent life threatening events between October 1985 and September 1988 (for 7,261 infants admitted into the pediatric unit during the same period), were submitted to the following investigations: careful anamnesis, complete clinical examination, systematic paraclinical investigations (standard biological studies, infectious and metabolic tests, investigations for gastro esophageal reflux (GER) and vagal hyper-reflectivity (VHR), polysomnography) or adapted to the clinical situation (toxic tests, brain computed scan, laryngoscopy, etc). Pathologies were mainly functional with neuro-vegetative immaturity (67.5%): gastro esophageal reflux (49%), vagal hyper-reflectivity (8.5%) or both (10%). An incidental pathological factor (breath holding spell, convulsion, intoxication, infection) was found in 18.5% of the infants, and 14% had normal results. Diphemanil 10 mg/kg/24h corrected the VHR and Metoclopramide 1 mg/kg/24h controlled 52% of the GER. The recurrence rate of illness in the GER and VHR groups was statistically lower with efficient therapy (12% vs 48%); no recurrence occurred in other groups.
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PMID:[Study of risk factors for recurrence in severe life-threatening conditions in infants]. 839 95

Twenty-four infants, 1 to 18 months-old, who were referred to four centers for suspected gastroesophageal reflux and whose esophageal pH after a standard formula meal given at 9 to 10 am (Ho-day 1) fulfilled the criterion of being < 4 for more than 5% of the time between H1 and H6, entered a double-blind placebo-controlled dose-response trial of metoclopramide (M). Twenty-four hours later (day 2), patients were randomly assigned to receive either placebo or a single 0.1, 0.2, or 0.4 mg/kg dose of metoclopramide, 30 min before the formula meal (n = 6/group) and the procedure was repeated. Metoclopramide plasma concentration was measured 1 h after dosing (C1h). On day 1, the time during which the esophageal pH was < 4 (time pH < 4), and five other parameters, were not significantly different in the treatment groups. On day 2, time pH < 4 (m(SD)) decreased from 33(13) to 30(33), 39(27), to 36(47), 42(15) to 18(13) and 48(25) to 31(46) min in the placebo, 0.1, 0.2, and 0.4 mg/kg metoclopramide groups, respectively. Possibly due to the large interindividual variability, no significant differences in parameters were observed between the different groups. None of the parameters correlated with the metoclopramide dose. Time pH < 4 expressed as the difference between day 1 and day 2, relative to day 1, decreased significantly as a function of C1h. No side effects were observed. A similar study should be performed after repeated dosing regimen.
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PMID:Dose-response study of metoclopramide in gastroesophageal reflux in infancy. 850 Jul 85

Metoclopramide (4-amino-5-chloro-N-2-methoxybenzamide) is a central and peripheral acting dopamine antagonist. It also stimulates motility in the upper gastrointestinal tract and increases lower esophageal sphincter pressure. In the pediatric population, it is used extensively as an antiemetic and in the treatment of gastroesophageal reflux disease. The case of a six-month-old infant who was accidentally overdosed with 24 mg (3 mg/kg) of metoclopramide within a nine-hour period is presented. The patient demonstrated toxic extrapyramidal effects. There have been multiple early reports in the European literature of acute extrapyramidal reactions in the pediatric population, but no reports of toxicity exist in the current emergency medicine literature.
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PMID:Metoclopramide toxicity in an infant. 951 31


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